Treatment of the chronically infected median sternotomy wound with muscle flaps.

While infection and dehiscence of the median sternotomy wound is a serious complication, débridement, sternal rewiring and wound irrigation will often result in wound healing. However, if these measures fail, radical débridement of all infected tissue and immediate reconstruction with muscle flaps is required and will give excellent results. The pectoralis major muscle based on the thoracoacromial artery is most satisfactory for this reconstruction. The rectus abdominis muscle, while also used, is not as effective because of variations in its proximal blood supply. The author describes 10 patients with chronically infected median sternotomy wounds, seen at St. Michael's Hospital in Toronto, in whom use of these techniques led to a rapid recovery with few complications.